Managing Healthcare Compliance in Maine

Sarah Jones
Outline of Maine over a healthcare photo

Maine, known for its picturesque rocky coastline, has specific healthcare regulations that can make navigating the industry a challenge. To sail smoothly through the complex rules and requirements, you need a deep knowledge of the most essential aspects of healthcare compliance in Maine. A successful compliance program involves adaptability, comprehensive planning, and insight into key compliance factors, including credentialing requirements. 

While Maine’s coast is an ideal destination for many, responsible healthcare professionals strive to dodge rocky compliance programs that increase legal and financial risks. Charting a path for healthcare compliance in Maine calls for knowing the ins-and-outs of the state’s unique healthcare regulations. Avoid feeling lost in a sea of rules — use this article as a compass for building a sturdy compliance program as steadfast as the coastline.

Maine Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

  • The Maine Department of Health and Human Services (DHHS) serves as a cornerstone in the state’s healthcare sector, dedicated to promoting and safeguarding the health and well-being of its residents through a wide range of public health and social services.
  • The Maine Hospital Association (MHA) is a pivotal organization that advocates for and supports hospitals and health care systems across Maine, striving to improve healthcare quality and accessibility for all Mainers.
  • MaineCare, operating under the Maine Department of Health and Human Services (DHHS), is the state’s Medicaid program, providing essential health coverage to eligible low-income residents, thereby enhancing access to quality healthcare services in Maine.
  • The Maine Board of Licensure in Medicine is a regulatory authority responsible for licensing and overseeing the professional conduct of physicians and physician assistants in Maine, ensuring the highest standards of medical practice and patient care.
  • The Maine Office of Professional and Occupational Regulation (OPOR) is a key state agency responsible for licensing and regulating various professions and occupations in Maine, including counselors and social workers

These agencies help maintain the integrity and quality of healthcare services in Maine, protecting the public and promoting patient safety. The resources provided by these Maine state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Maine.

Regulations Unique to Maine

To meet the standards of healthcare compliance in Maine, there are a few additional regulations. For example, both the Certificate of Need and licensing requirement programs work to ensure state standards are met, promoting quality care and balanced healthcare services. 

Certificate of Need Required

In Maine, the Certificate of Need (CON) is a regulatory program that requires certain types of healthcare providers to obtain state approval before making major changes. This regulation, as per 22 MRSA Chapter 103-A, requires healthcare facilities to obtain state approval for a variety of activities, including mergers and acquisitions, the establishment of new healthcare facilities or services, substantial capital investments in new equipment or facilities, modifications in the accessibility of services, and increases in bed complement​​.

The CON regulation ensures that any major shifts in Maine’s healthcare environment are carefully evaluated and approved by the state, maintaining a balance between the needs of the community and the growth of healthcare services. It reflects Maine’s commitment to overseeing and managing its healthcare system responsibly, ensuring that changes align with both state regulations and the overall welfare of its residents.

Hospital Licensing Regulations and Requirements

Maine’s Division of Licensing and Certification under the Department of Health and Human Services (DHHS), has established a diverse set of rules for the licensing of various types of healthcare providers, including hospitals, ambulatory surgery centers (ASCs), and skilled nursing facilities. The Division of Licensing and Certification is a critical regulatory framework for healthcare executives and compliance officers. The set of rules is designed to ensure that hospitals and other entities in Maine adhere to state-specific standards, focusing on maintaining high levels of patient care and safety. The rules cover various aspects of operations, including administrative procedures, facility requirements, and quality control measures. These regulations are integral to guiding hospitals in Maine towards compliance with state health laws and policies, thereby ensuring that they provide safe, effective, and quality healthcare services to all patients.

Tips To Manage Healthcare Compliance in Maine

Effectively managing healthcare compliance in Maine is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

  • Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Maine-approved training.
  • Organize Policies By Requirement: Including “ME” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
  • Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
  • Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Maine

To enroll with Medicaid in Maine, healthcare providers and credentialers must navigate a detailed credentialing process with MaineCare. The steps include completing the Provider Enrollment Application (PEA) through the Health PAS Online portal, which is the Maine Integrated Health Management Solution (MIHMS). Completing risk level screenings and securing a National Provider Identifier (NPI) as per National Plan and Provider Enumeration System (NPPES) and Centers for Medicare and Medicaid Services (CMS) standards are essential. Enrollment also entails an annual fee and, for certain providers, like Home Health Agencies (HHAs) and Durable Medical Equipment (DME), surety bonds. Billing compliance requires the NPI of an enrolled MaineCare practitioner for ordering, prescribing, or referring services. Providers must revalidate their MaineCare enrollment every five years, or three years for DME providers. Credentialer and providers can refer to the MIHMS Enrollment Guide for further details.

Meet Maine Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Maine

MedTrainer’s all-in-one compliance platform can streamline management of Maine healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!